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General NPI Number Information
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NPI Number | 1285760926
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Entity Type | Organization
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Legal Business Name | MIDDLETOWN EYE CARE PLLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 13324 SHELBYVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-3936
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Country | US
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Telephone | 502-245-9568
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Fax | 502-254-1425
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Provider Business Mailing Address
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Address Line | 13324 SHELBYVILLE RD
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City | LOUISVILLE
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State | KY
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Zip | 40223-3936
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Country | US
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Telephone | 502-245-9568
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Fax | 502-254-1425
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Authorized Official
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Title or Position | OPTICAL MANAGER
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Name | CRAIG DONOHO
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Credential |
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Telephone | 502-245-9568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 25403
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License Number State | KY
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